The Journal of the Association of Physicians of India最新文献

Background: Assessment of diabetes health takes into account metabolic, nonmetabolic, and self-care measures like diet, exercise, follow-up, and habits. On the other hand, the index of complications includes the macro- and microvascular complications of diabetes along with foot complications. The Blue Index (BI) is a composite assessment of both diabetic health-related parameters and systemic complications stemming from diabetes. The present study aimed to evaluate the diabetes control status of the patients as a single index.

Methods: A prospective, observational study included a total of 100 adult diabetic patients in whom diabetic health status (DHS) and Komplications Score (KS) were assessed for cardiovascular/macrovascular, microvascular, and foot complications. The BI was calculated as a composite ratio, and measures were obtained at baseline, after 3 months, and at 6 months. Data were statistically analyzed.

Results: Diabetic health status significantly increased at the 3rd month and the 6th month, respectively, compared to baseline (p = 0.000). KS significantly decreased at the 3rd month and the 6th month, respectively, compared to baseline measures (p = 0.000). The composite BI scores showed a steady increase of 9.62 at the 3rd month and 13.14 at the 6th month, respectively, compared to baseline. Assessing based on the duration of diabetes detection, the scores of DHS, KS, and BI showed similar changes. Assessing based on patients' gender, DHS was significantly higher in females at baseline compared to males, with gradual improvement in scores over time for both genders. Contrastingly, KS was significantly lower in males compared to females, with scores showing gradual decrement over the time frame, signifying improvement in complications. DHS was significantly correlated with the duration of diabetes detection (p = 0.001) and age (p = 0.01).

Conclusion: The BI is a simple tool that incorporates various parameters covering different aspects of diabetes care, including complications. It may be used not only by endocrinologists but also by all physicians as a tool to monitor and improve diabetic care.

This article provides an overview of the diabetic kidney disease paradigm, explaining important aspects such as prognostic markers, clinical assessments, and therapeutic options. The importance of the term gluconephrotic syndrome (GlucoNS) is emphasized, highlighting its significant influence on clinical evaluations, research procedures, screening techniques, and patient care. This term encapsulates nephrotic syndrome (NS) within the diabetic milieu, shedding light on the intricate relationship between renal complications and diabetes. GlucoNS necessitates a refined approach, considering the unique challenges posed by diabetes in the context of NS. With this review, we want to highlight how important it is to assess diabetes in every case of NS and how important it is to assess albuminuria in every diabetic patient.

Osteonecrosis, characterized by ischemic bone injury leading to cell death and bone resorption, manifests in various anatomical sites due to multiple etiologies such as radiotherapy and medications. While certain sites like the femoral head and jaw have garnered attention, vertebral body osteonecrosis remains less explored and lacks a standardized classification system. This report presents a unique case of a 52-year-old woman undergoing chemotherapy for diffuse large B-cell lymphoma who developed multilevel vertebral body osteonecrosis, a rare occurrence in English medical literature. The patient presented with fever, abdominal pain, and lymphoid malignancy markers, initiating chemotherapy with the rituximab, cyclophosphamide, vincristine, and prednisolone (R-CVP) regimen. During treatment, she experienced breathing difficulties and back pain, prompting imaging studies revealing extensive osteonecrosis affecting multiple vertebrae and other skeletal sites. Various factors, including chemotherapy, human immunodeficiency virus (HIV) therapy, trauma, and others, contribute to vertebral body necrosis. While osteonecrosis in lymphoma patients is rare, chemotherapy-induced marrow necrosis can lead to bone involvement. Vertebral bodies, especially their anterior portions, are susceptible due to limited blood supply. The presence of an intravertebral vacuum cleft on radiographs is pathognomonic for osteonecrosis, while magnetic resonance imaging (MRI) reveals hypointense areas and fluid collections. This case underscores the complexity of diagnosing and managing multilevel vertebral body osteonecrosis, exacerbated by the lack of standardized protocols. The interplay between disease processes and treatment modalities complicates decision-making, emphasizing the need for further research to establish optimal diagnostic and treatment guidelines. In conclusion, this case sheds light on a rare manifestation of osteonecrosis in a lymphoma patient, highlighting the challenges in diagnosis and management. Further research is warranted to enhance understanding and improve outcomes for patients with this debilitating condition.

Majority of the eclampsia or preeclampsia occur between 20 weeks of gestation and within 48 hours postpartum. Postpartum eclampsia usually occurs on a background of preeclampsia. Late postpartum eclampsia (LPE) without preeclampsia is a rarity. LPE with posterior reversible encephalopathy syndrome (PRES) and mild hypertension is extremely rare. We report a case of LPE with PRES without preeclampsia, at a blood pressure of 140/90 mm Hg. Seizures occurring late postpartum period could be due to LPE and this can occur even with mild hypertension.

Plasma cell invasion of the kidney in plasma cell dyscrasia is rare. We are reporting a case of plasma cell infiltration in the kidney presenting as rapidly progressing renal failure. The patient presented with generalized weakness, anemia, and advanced renal failure. The kidney biopsy revealed multifocal atypical CD138-positive plasma cell-rich interstitial inflammation and severe acute tubular injury. In the present situation of clinically unexplained renal failure with suspicion of plasma cell dyscrasia, a kidney biopsy proved to be key to the diagnosis. Hence, malignant plasma cell infiltration in the kidney could indicate underlying plasma cell dyscrasia and may serve as a future myeloma defining event (MDE).

Aim: To evaluate thyroid nodules with sonoelastography and magnetic resonance imaging (MRI).

Materials and methods: The study included 28 patients with 40 thyroid nodules. Clearance was obtained from the institute's ethical clearance committee. Patients with pure cystic nodules or nodules with eggshell calcification, diffuse thyroid pathology (such as Graves' disease, Hashimoto's thyroiditis, De Quervain thyroiditis, and Riedel's thyroiditis), inaccessible nodules via fine needle aspiration cytology (FNAC), or patients with a history of thyroid gland surgery were excluded from the study. Strain elastography was performed on a Phillips iU22 machine, producing qualitative color-coded strain maps (graded using the Rago 5-point system) and semiquantitative strain ratios. MRI was performed on a Phillips ACHIEVA 1.5T magnet with a head and neck coil.

Results: Rago scores statistically correlated (χ² = 18.052, p < 0.001) with malignant nodules, and using the receiver operating characteristic (ROC) curve, the area under the ROC curve (AUROC) for the mean strain ratio predicting malignant outcomes was 0.88 [95% confidence interval (CI): 0.767-0.992], which was also statistically significant (p < 0.001). A cutoff of mean strain ratio ≥2.48 predicted malignant outcomes with 100% specificity. T2 signal intensity ratio (SIR) and apparent diffusion coefficient (ADC) values were not statistically significant in predicting malignant outcomes. Kinetic curves were statistically significant for Rago scores (χ² = 11.356, p = 0.045); however, no significant difference was found in predicting malignant outcomes.

Conclusion and clinical significance: We concluded that sonoelastography, along with grayscale ultrasound, is a useful noninvasive technique for predicting histological outcomes. However, MRI should largely be reserved as a problem-solving tool rather than a standalone imaging modality. The kinetic curves show some degree of overlap between histologically distinct diseases, and thus large-scale multicenter trials are needed for further standardization.

Many among us and some students have a personal idiosyncrasy to remember eponyms in clinical medicine and other subjects such as signs, tests, phenomena, and rules named after a person who originally described them. However, it is not always necessary as long as one knows what they mean. Józef Brudziński's name is given to four eponymous medical signs associated with reflexes observed in meningeal irritation along with Kernig's sign.

Traumatic brain injury (TBI) causes significant mortality and morbidity across regions, imposing a substantial socioeconomic burden on societies. A major complication that can arise is uncontrolled intracranial pressure (ICP). Several strategies exist for reducing ICP in TBI patients, including head elevation, mannitol administration, and hyperventilation. Decompressive craniectomy (DC) is a therapeutic approach employed to lower ICP. This technique offers immediate and permanent relief from elevated ICP, although there are ongoing debates regarding its beneficial use and appropriate indications for patients with increased ICP. The objective of this review was to assess variations in surgical technique, timing of the procedure, and patient characteristics associated with DC. Through the evaluation of clinical and radiologic data concerning DC in patients with elevated ICP, it was revealed that while DC provides numerous benefits, it also carries a significant risk of mortality and morbidity. Furthermore, we observed that factors such as age, initial Glasgow Coma Scale (GCS) score, pupil response, and the time interval between injury and DC can serve as predictors for the procedure's outcomes. Based on our findings, we recommend conducting further trials to shed light on the use of DC in TBI patients.

We present a case of Streptococcus iniae causing leptomeningitis, pyocephalus, and subdural empyema in an elderly male from India. There have been only a handful of cases of S. iniae infection reported worldwide, and none of them have been from India. In this case, an elderly diabetic patient presenting with backache, headache, and fever with severe neurological worsening was diagnosed with severe invasive S. iniae infection. He had hydrocephalus that needed ventriculoperitoneal shunting. The patient was treated with a prolonged course of intravenous ampicillin and vancomycin.